Carotid-Cavernous Fistula

Carotid-cavernous fistulas are abnormal vascular communications between the carotid artery or its branches and the cavernous sinus. They often present with visual symptoms and signs, such as proptosis, chemosis, diplopia, or conjunctival injection. In this chapter, we begin by reviewing the types of carotid-cavernous fistula and their respective causes. We next discuss the symptoms, signs, and potential complications of carotid-cavernous fistula. We then discuss noninvasive imaging approaches for the diagnostic evaluation of carotid-cavernous fistula, although digital subtraction cerebral angiography is necessary for definitive diagnosis. Lastly, we review the management options for carotid cavernous fistula, including approaches that can minimize or address potential visual complications.